Rheumatoid arthritis (RA) can be debilitating. With severe inflammation in the joints, people endure severe pain and restricted mobility.
The condition can be managed through drug therapy along with a healthy and active lifestyle that includes a fitness routine. However, if rheumatoid arthritis is left unaddressed, and it reaches the cervical spine (C1 and C2 vertebrae of the spinal cord), the inflammation could lead to fatal complications, say experts.
Rheumatoid arthritis is an auto-immune condition where the body’s immune system starts attacking the joint tissues. Initially, it affects only the small joints. But if the condition advances, it can affect various systems of the body like the cardiovascular system as well as the cervical spine.
The cervical spine gets affected by rheumatoid arthritis at an advanced stage. The chances of RA reaching that stage are rare considering the access and reach of treatment protocols. However, RA in cervical spine can affect the C1 and C2 vertebrae severely, and an immediate surgery is recommended.
How rheumatoid arthritis affects the cervical spine
A 2015 research paper lists out how rheumatoid arthritis in the cervical spine leads to a host of complications:
- It can result in atlantoaxial instability (several ligaments in atlantoaxial segment, C1 and C2, produce the stability required to prevent neurological injury).
- It can trigger cranial settling (an instability which causes an upward migration or rotation of the C2 complex into the cranium or skull).
- It can lead to dislocation of the cervical spine or subaxial subluxation.
The paper adds that disease modifying anti-rheumatic drugs (DMARDs) and biological agents have shown to decrease the chances of progression of RA into the cervical spine. However, once it occurs, drugs are of no use. If left untreated, it could lead to severe neurological morbidities and even death.
Symptoms of RA in cervical spine
“Initially, erosion of joints take place when the condition is at an advanced stage and is untreated,” says Dr Mukhtar Masoodi, senior rheumatologist and director of Rheumax Arthritis and Rheumatology Centre, Srinagar, Jammu & Kashmir. “And at last, it can affect the cervical joints, which causes subluxation and can be fatal.”
There are telltale pain patterns which indicate if rheumatoid arthritis has touched the cervical spine.
“The person experiences neck pain, vertiginous effect where the person feels he or she has vertigo, and along with which the pain is also radiated to both the arms,” adds Dr Masoodi. “Factors like osteoporosis, improper posture and inflammation of the joint not being treated also aids in the cervical spine being affected.”
Treatment and precautions
Once it is established that rheumatoid arthritis has reached the cervical spine, surgery is the final option. Some precautions can be taken to prevent such a situation.
“Surgery is the last option for the treatment of cervical spine because if there is subluxation then it can prove fatal,” says Dr Masoodi. “Apart from this, physiotherapy is the cornerstone of rheumatoid arthritis treatment. So, the sessions should be done regularly, and a patient should not miss out on the medicines prescribed. Regular visits to the rheumatologist should be done to monitor and prevent the situation from getting aggravated.”
Takeaways
- Rheumatoid arthritis, if left untreated and allowed to reach an advanced stage, affects the cervical spine (C1 and C2 vertebrae).
- Neurological symptoms such as headaches, neck pain and vertigo are experienced by those having RA in the cervical spine.
- Surgery is the last option available for rheumatoid arthritis of the cervical spine. However, following a regular drug therapy, physiotherapy sessions and regular visits to a rheumatologist can prevent the condition from worsening.
